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The Egyptian Journal of Bronchology
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Value of C-reactive protein in differentiation between tuberculous and malignant pleural effusion

Egyptian Journal of Bronchology volume 11, pages 49–55 (2017)Cite this article

Abstract

Background

Few studies had reported the value of Creactive protein (CRP) in differentiating between tuberculous pleural effusion (TBPE) and malignant pleural effusion (MPE).

Aim

The aim of this study was to investigate the diagnostic value of CRP in differentiating between TBPE and MPE.

Settings and design

This prospective study was conducted in a University Hospital.

Patients and methods

During a period of 18 months, a prospective study included 59 adult patients with pleural effusion. The study included two groups: group I, which included 29 patients with TBPE, and group II, which included 30 patients with MPE. Serum C-reactive protein (s-CRP) and pleural fluid C-reactive protein (p-CRP) were measured and compared in both groups, using enzyme-linked immunosorbent assay.

Results

The mean values of s-CRP were 28.34±14.41 and 27.87±13.21 mg/dl in TBPE and MPE, respectively, with no significant difference. The mean values of p-CRP were 36.51 ±3.91 and 26.39±7.57 mg/dl in TBPE and MPE, respectively, with a highly significant difference (P=0.001). There were significantly positive correlations between s-CRP and p-CRP in both TBPE and MPE (r=0.685 and P=0.001; r=0.594 and P=0.006, respectively). With the use of cutoff values of 31.6 and 43.3 mg/l for p-CRP and s-CRP, sensitivity and specificity were 89.47 and 80.00% for p-CRP, and 15.79 and 100.00%, respectively, for s-CRP. The area under the receiver operating characteristic curve of p-CRP was 0.888, superior to that of s-CRP (0.525).

Conclusion

Measurement of CRP levels in the pleural fluid has a good utility in the diagnostic workup of patients with pleural effusion. p-CRP can be a useful adjunctive test, as a potential differentiator between TBPE and MPE.

References

  1. Kapisyzi P, Dikensoy Ö, Argjiri D. Acute inflammation biomarkers in pleural effusions. Derleme 2012; 13:53–55.

    Google Scholar 

  2. Porcel JM. Pearls and myths in pleural fluid analysis. Respirology 2011; 16:44–52.

    Article  Google Scholar 

  3. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest 2003; 111:1805–1812.

    Article  CAS  Google Scholar 

  4. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999; 340:448–454.

    Article  CAS  Google Scholar 

  5. Smith RP, Lipworth BJ. C-reactive protein in simple community-acquired pneumonia. Chest 1995; 107:1028–1031.

    Article  CAS  Google Scholar 

  6. Abu-Youssef H, Amin S, Amin H, Osman E. Value of C-reactive protein in etiologic diagnosis of pleural effusion. Egypt J Bronchol 2010; 4: 124–130.

    Google Scholar 

  7. Samaha HMS, Elsaid AR, Elzehery R, Elhelaly R. C-reactive protein and serum amyloid A levels in discriminating malignant from non-malignant pleural effusion. Egypt J Chest Dis Tuberc 2015; 64:887– 892.

    Article  Google Scholar 

  8. El-Shimy WS, Attia GA, Hazzaa SM, Mansour YM, Abd El-Halim WM. Diagnostic value of procalcitonin and C-reactive protein in differentiation between some benign and malignant pleural effusions. Egypt J Chest Dis Tuberc 2014; 63:923–930.

    Article  Google Scholar 

  9. Chierakul N, Kanitsap A, Chaiprasert A, Viriyataveekul R. A simple Creactive protein measurement for the differentiation between tuberculous and malignant pleural effusion. Respirology 2004; 9:66–69.

    Article  Google Scholar 

  10. Sedky M, Radwan I, Mohamed M. C-reactive protein in differentiation between tuberculous and malignant pleural effusions. Eur Respir J 2011; 38:2715.

    Google Scholar 

  11. Light RW. Clinical practice. Pleural effusion. N Engl J Med 2002; 346:1971–1977.

    Article  Google Scholar 

  12. Steel DM, Whitehead AS. The major acute phase reactants: C-reactive protein, serum amyloid P component and serum amyloid A protein. Immunol Today 1994; 15:81–88.

    Article  CAS  Google Scholar 

  13. Pepys MB, Baltz ML. Acute phase proteins with special reference to Creactive protein and related proteins (pentaxins) and serum amyloid A protein. Adv Immunol 1983; 34:141–212.

    Article  CAS  Google Scholar 

  14. Vigushin DM, Pepys MB, Hawkins PN. Metabolic and scintigraphic studies of radioiodinated human C-reactive protein in health and disease. J Clin Invest 1993; 91:1351–1357.

    Article  CAS  Google Scholar 

  15. Garcia-Pachon E, Soler MJ, Padilla-Navas I, Romero V, Shum C. Creactive protein in lymphocytic pleural effusions: a diagnostic aid in tuberculous pleuritis. Respiration 2005; 72:486–489.

    Article  CAS  Google Scholar 

  16. Park DS, Kim D, Hwang KE, Hwang YR, Park C, Seol CH, et al. Diagnostic value and prognostic significance of pleural C-reactive protein in lung cancer patients with malignant pleural effusions. Yonsei Med J 2013; 54:396–402.

    Article  CAS  Google Scholar 

  17. Elsammak MMY, Morsi TS, Khamis HI, Ragab MS, Zaki MA, Abdel-Hadi M, Hassan HA. Osteopontin and C-reactive protein in Egyptian patients affected with tuberculous and malignant pleural effusion. Ann Clin Biochem 2007; 44(Pt 3):264–272.

    Article  Google Scholar 

  18. Heikkilä K, Ebrahim S, Lawlor DA. A systematic review of the association between circulating concentrations of C reactive protein and cancer. J Epidemiol Community Health 2007; 61: 824–833.

    Article  Google Scholar 

  19. Scott HR, McMillan DC, Forrest LM, Brown DJ, McArdle CS, Milroy R. The systemic inflammatory response, weight loss, performance status and survival in patients with inoperable non-small cell lung cancer. Br J Cancer 2002; 87:264–267.

    Article  CAS  Google Scholar 

  20. Botana-Rial M, Casado-Rey P, Leiro-Fernández V, Andrade-Olivié M, Represas-Represas C, Fernández-Villar A. Validity of procalcitonin and C-reactive protein measurement when differentiating between benign and malignant pleural effusion. Clin Lab 2011; 57:373–378.

    CAS  PubMed  Google Scholar 

  21. Turay YU, Yildirim Z, Turkoz Y, Biber C, Erdogan Y, Keyf AI, et al. Use of pleural fluid C-reactive protein in diagnosis of pleural effusions. Respir Med 2000; 94:432–435.

    Article  Google Scholar 

  22. Ji Q, Huang B, Wang M, Ren Z, Zhang S, Zhang Y, et al. Pleural fluid prealbumin and C-reactive protein in the differential diagnosis of infectious and malignant pleural effusions. Exp Ther Med 2014; 7:778–784.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Assiut University, Assiut, 71516, Egypt

    Sherif A. A. Mohamed (MD), Gamal R. Agmy, Safaa M. Wafy & Montaser G. A. Abd El-Hameed

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  1. Sherif A. A. Mohamed
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  2. Gamal R. Agmy
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  3. Safaa M. Wafy
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  4. Montaser G. A. Abd El-Hameed
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Correspondence to Sherif A. A. Mohamed.

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Mohamed, S.A.A., Agmy, G.R., Wafy, S.M. et al. Value of C-reactive protein in differentiation between tuberculous and malignant pleural effusion. Egypt J Bronchol 11, 49–55 (2017). https://doi.org/10.4103/1687-8426.198999

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  • DOI: https://doi.org/10.4103/1687-8426.198999

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